Scientists proposing to study SARS at Bethesda-based NIH

Erika NiedowskiSun Staff

As troubling new questions emerged about SARS overseas, federal researchers here at home continued yesterday preparing to bring infected patients to the Bethesda-based National Institutes of Health to learn more about how the virus affects the body.

Scientists have proposed studying SARS patients - those still ill and those who have recovered - at the NIH Clinical Center to help unlock some of the mysteries surrounding the coronavirus thought to be behind the worldwide outbreak.

"The idea is to understand better several continually puzzling aspects of the disease," said Dr. Anthony Fauci, director of the NIH's National Institute for Allergy and Infectious Diseases.

Among the concerns are how much of the virus is present in the body, how the body tries to overcome it and whether infected people whose symptoms have cleared up are capable of passing the virus on to others.

"When people get better, is the virus still present in the body? And, if it is, why doesn't the body totally eliminate the virus?" said Fauci. "There are so many questions that you need to ask, even with the convalescent people."

The hospital would probably admit two SARS patients at a time for stays ranging from a few days to a few weeks.

Recovering patients could come from all over the country, Fauci said. Seriously ill patients would probably come from the Washington area and nearby states.

Critics of the plan - which has not been approved - say that introducing the disease into a clinical environment is a bad idea because of the danger it poses to other patients and the hospital staff.

Fauci said safety is the top concern.

"We would not be engaged in this sort of thing unless we felt convinced that we'd be able to protect our own physicians and nurses and health care providers, as well as patients themselves in the hospital," he said.

The hospital is equipped with isolation rooms that would prevent contaminated air from circulating throughout the building, and patients would wear protective gear while being transported from one area of the hospital to another.

Voluntary study

The clinical study, which would be voluntary, could help lead to an effective treatment for the disease or a vaccine that protects against it.

The study could also help answer disturbing new questions raised this week in Hong Kong, where health authorities reported that 12 patients who seemed to have recovered suffered relapses.

The patients, all of whom had been released from the hospital, could have been infected a second time, or they might have been sickened again because the virus had not been defeated but was hiding in their bodies.

"The reason for that might be there still is virus sequestered in people who appear to be well," said Fauci.

With some diseases, such as chicken pox, those who get them become immune. Other illnesses, such as the common cold or the flu, can be contracted repeatedly.

Doctors aren't sure what protection SARS patients might have.

According to the World Health Organization, which is leading the fight against the disease, SARS has sickened 5,865 people worldwide and killed 391.

The overall mortality rate has climbed steadily from 3 percent at the beginning of the outbreak to about 6.7 percent, though it has been much higher in some countries.

In Canada, it has been 13.6 percent. By contrast, in most years, influenza kills fewer than 1 percent of those who come down with it.

The NIH's Clinical Center, a 14-story building with 5,000 rooms and more than 1,600 labs, is one of the world's largest research hospitals. Scientists there study such things as stroke, skin diseases, chronic pain and cancer.

Dr. Robert Edelman, associate director for clinical research at the University of Maryland School of Medicine's Center for Vaccine Development, said the NIH is a logical place to carry out such a clinical research study, even with the potential risk.

The hospital treats many immunocompromised cancer patients who would be particularly susceptible to infections.

"If this was a trivial problem but still had something of a risk, I don't think it would be reasonable to expose the people there to the risk," said Edelman.

"But since the problem is of such great international, global magnitude, it's definitely worth the risk. ... It allows [researchers] to get some of the work done, maybe either more expeditiously or with more thoroughness. It has that promise."